Perioperative predictors of early surgical revision and flap-related complications after microvascular free tissue transfer in head and neck reconstructions: a retrospective observational series
| Autor: | Manuel Waser, Claudia Lädrach, Jelena Pfister, Lukas M. Löffel, Roland Giger, Radu Olariu, Benoit Schaller, Dominique Engel, John-Patrik Burkhard, Patrick Y. Wuethrich, Markus Huber |
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| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
610 Medicine & health Free flap 030230 surgery Norepinephrine (medication) 03 medical and health sciences 0302 clinical medicine medicine Head and neck General Dentistry business.industry Perioperative Surgery Tissue transfer Vasopressor 030220 oncology & carcinogenesis Fluid overload Original Article Dobutamine Observational study Revision surgery Complication business medicine.drug |
| Zdroj: | Burkhard, John-Patrik; Pfister, Jelena Elisa; Giger, Roland; Huber, Markus; Lädrach, Claudia; Waser, Manuel; Olariu, Radu; Engel, Dominique; Löffel, M.; Schaller, Benoît; Wüthrich, Patrick Y. (2021). Perioperative predictors of early surgical revision and flap-related complications after microvascular free tissue transfer in head and neck reconstructions: a retrospective observational series. Clinical oral investigations, 25(9), pp. 5541-5550. Springer 10.1007/s00784-021-03864-1 Clinical Oral Investigations |
| DOI: | 10.1007/s00784-021-03864-1 |
| Popis: | Objectives The aim of this study was to determine the influence of perioperative fluid management and administration of vasopressors on early surgical revision and flap-related complications in free tissue transfer. Materials and methods Intraoperative amount of fluid and of vasopressors, relevant perioperative parameters, and comorbidities were recorded in 131 patients undergoing head and neck microvascular reconstruction and compared with early surgical complications, defined as interventions requiring surgery after a flap-related complication, and/or other surgical problems in the operating room within 30 days after initial surgery. The relationship between perioperative variables for each revision category was determined using an optimized multiple logistic regression. Results The administration of diuretics (p=0.001) as a treatment for perioperative fluid overload and the type of flap (p=0.019) was associated with a higher risk of early surgical revisions. Perioperative fluid overload (p=0.039) is significantly related to flap-related complications. We found no effect of intraoperative administration of vasopressors on early surgical revisions (p=0.8) or on flap-related complications (norepinephrine p=0.6, dobutamine p=0.5). Conclusion Perioperative fluid overload is associated with higher risks of early surgical revision and flap-related complications. In contrast, the administration of vasopressors seemed to have no effect on either surgical revision rate or flap-related complications. Clinical relevance In patients receiving microvascular reconstructions, a balanced fluid administration perioperatively and a targeted use of vasopressors should be the necessary strategy to reduce the complication rates in head and neck surgery. |
| Databáze: | OpenAIRE |
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